About 17 years ago, I was working as a contract forestry surveyor in Washington state, running cutting lines for Boise Cascade. The project we had been working on took us about 8 weeks to complete, and on the last day of work we were looking forward to a sizable (and much needed) paycheck.
The final hike back to the truck was down a rather steep hillside, and, though I knew it was a dangerous thing to do, being a "skilled professional", I was using my machete as a walking stick to help support my descent.
The truth is, I didn't grow up in the woods and was rather clumsy, falling frequently. The only reason I was doing this work was because I needed a job, and a friend offered to hire me. It turned out to be good exercise for me, and I actually grew to enjoy the outdoor experience. What I had learned, but had yet to master, was that walking in the woods wasn't like walking in the park.
So, on this last
day of work on this particular project, predictably, I slipped and fell while traversing the steep decline, and sliced my left palm on my machete.
Though there was no pain (perhaps because there was no pain), I knew it was bad before I looked. The cut was on my "life line", right below my index finger. What I suspected, was later confirmed: the cut went deep enough to sever the nerve on the thumb side of my finger. I had no feeling from the cut to the tip of my finger.
Though a hand specialist told me it would be a mistake to not repair the nerve, I was inclined to avoid surgery. My father had nearly cut the ring finger on his left hand off when he was a boy, and lived the rest of his life bending it by overlapping it with his middle finger to pull it down. I figured I could function in a similar manner.
The doctor said that the inside and outside of the thumb, the thumb side of the index finger, and the outside of the "pinky" are the most critical areas to maintain feeling in order for the hand to function. Because I'm left handed this was especially true. He predicted that, if I didn't have surgery, I would wind up using my middle finger as an index finger, and my index finger would eventually become stiff and unbendable from lack of use.
At the urging of my wife, my father, and friends, I decided to have the surgery.
This is where my education on the body's nervous system began. I asked question after question, wanting to get my money's worth in knowledge about what had happened, and what was to be done to repair the damage.
What I learned was that our nerves are encased in a "sheath" about the size of a human hair, and that inside this sheath are tens of thousands of nerve fibers which convey information to the brain through the nerve cells. The "sheath" containing the nerves to the thumb side of my index finger had been severed, and because it is somewhat elastic, the two sides retracted from one another ensuring that they would never grow back together on their own.
Through micro surgery, the doctor was able to put three sutures into the nerve sheath (picture sewing two pieces of hair together), and my hand was put in a cast to keep me from tearing the sutures out while the sheath grew back together. I wore the cast for two weeks.
If you've never had it done to you, you cannot imagine what happens to your fingers if you do not move them for 2 weeks. The doctor explained that the cartilage in your joints is lubricated by synovial fluid that, if not kept fluid (by frequent motion) turns into a solid. When the cast was removed I discovered that all the joints in my hand had swollen to about twice their normal size, I could not bend my fingers, and that to try to bend my fingers caused pain that caused tears. Regardless, I was given 2 weeks to be able to make a fist, with the threat that if I could not do it on my own, I would do it with "help".
I won't bore you with the details of The Agony and the Ecstasy of Howard Making a Fist, except to say that I succeeded before my 2-week followup appointment. It was at this meeting that my education continued.
I learned that the surgery only joined the two ends of the nerve sheath, and that the rest of the healing would be accomplished by my body. The doctor told me that bringing the ends together only made it possible for the nerves to reconnect, but that a wall of scar tissue would have to be penetrated before that could happen. Amazingly, our bodies are designed so that the nerve fibers seek out these connections, and eventually grow through the scar tissue to find a mate on the other side. This process, though it would continue for the rest of my life, would probably only result in a 15% success rate. The good news, however, is that only 1% was necessary in order for my finger to be usable.
I also discovered that this process was already well on it's way. The doctor used a tool that "scratched" the tip of my finger to test for feeling. He also tested the area near the surgery site. To my surprise, I was able to feel the stimulation, but not like I expected. What happened was, when the doctor stimulated the tip of my finger, I felt it at the surgery site, and vise versa. He said this was normal, and that as the nerves were repaired, the sensation would grow progressively closer to the actual place of stimulation.
The other thing that was evident was that, though there was a tingly numbness, the sensation of feeling was very acute. I was told that the way our nerves work is to transmit messages to the brain through the nerve cells, as previously mentioned. More specifically, to indicate a touch, a few cells send the message, but for pain, many more cells send the same message, the number of cells used increasing as the stimulus increases. In my case, however, because I had sustained catastrophic damage, all the available cells are used regardless of the intensity of the stimulus.
Indeed, since the surgery, the slightest nick or splinter or burning of my finger has caused a feeling of pain that has been difficult to ignore. As more nerve fibers have reconnected, this annoyance has lessened as the nerves have been retrained.
This brings us to the pain I felt all day yesterday. I was told that whenever a new connection was made, that particular nerve would begin transmitting pain messages, in a sense announcing that it was "back in business". From experience, I know that this pain will last a few of days, then gradually subside. I've learned to embrace this pain with thankfulness that my body is still healing itself.
I wanted to take the time to write this in the hope that some of you will be awed (as I am) at how, to quote the psalmist, "fearfully and wonderfully" we are made. Our nervous systems are just one bodily system that we take for granted until something happens to interrupt its operation.
As we study the human body, our awe increases with our understanding (at least mine does), and there are many things we just don't understand, but accept as fact.
Perhaps most amazing is the body's ability to heal and regenerate itself with a minimum of help from us. If we just give it a little food, a little water, a little rest, a little protection, and a little nurturing, our bodies continue to function as designed for around "three score and ten" years (also by design). In many cases this function takes place without our even noticing, and in spite of our habits that hinder it.
My hope is, that after reading this, you will be able to be thankful for the pain you feel when injured, understanding a little of what is going on to create the sensation. I know I am!
